Provider Demographics
NPI:1487161832
Name:KEENE, RENAE M
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:M
Last Name:KEENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:09 AKULMIUT STREET
Mailing Address - Street 2:
Mailing Address - City:KASIGLUK
Mailing Address - State:AK
Mailing Address - Zip Code:99609
Mailing Address - Country:US
Mailing Address - Phone:907-477-6210
Mailing Address - Fax:907-477-6120
Practice Address - Street 1:09 AKULMIUT STREET
Practice Address - Street 2:
Practice Address - City:KASIGLUK
Practice Address - State:AK
Practice Address - Zip Code:99609
Practice Address - Country:US
Practice Address - Phone:907-477-6210
Practice Address - Fax:907-477-6120
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker